Mandatory Vaccinations in the United
States of America

            In today’s society, shaping our
children’s futures is not only a mental aspect but  also a physical one. In the past, it has been
widely accepted in America that vaccinations promote the well being of the
population and prevent disease outbreaks from occurring. Currently, however, a
growing hesitation and skepticism regarding childhood vaccines is causing a
reappearance of vaccine preventable illnesses (Hendrix et al.) The goal of this paper is to
investigate mandatory vaccination and the many factors associated with the
parental decision to abide by or object to these requirements, and present the ethical
argument for both perspectives on compulsory immunization in the United States
of America.

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To achieve this goal, this paper is
divided into four sections. First, I will explain the history behind vaccine
laws in the U.S. and discuss the impact it has on today’s society. Then, I will
discuss the factors that have an influence on families’ choices in regards to
vaccinating their children. Lastly, I will provide the debate in favor and not
in favor of mandatory immunizations and conclude with the advocacy for vaccine
regulations in America.

History of Vaccination Laws

The first U.S. law for immunizations appeared in United States in the 19th
century when smallpox outbreaks were prevalent. This is when vaccinations
became widely accepted by the population as a reliable health intervention for
preventing the spread of disease (Omer et al.) Because vaccinations were
extremely successful at this point in time, many states started to enforce laws
regarding mandates to receive them and in turn caused a decline in
administration rates (Omer et al.). In 1905, the U.S. Supreme Court approved
the rights of states to enact their own vaccination laws, and seventeen years
later mandatory school immunization requirements were ruled constitutional
(Omer et al.). In the 1960s and 70s, measles was at an all time high and ultimately
gave the big push into the modern era of immunization laws. By 1980, school
immunization requirements were applied by all 50 states (Omer
et al.). There is no national
legislation concerning vaccinations but state laws require children to be
vaccinated in order to be eligible for enrollment in public and private school
(Welborn). Most educational institutions follow the Centers for Disease Control
and Prevention schedule of immunizations as a guide for administering vaccines at
certain ages (Welborn). Since the U.S. has implemented school vaccine
requirements, there has been a significant decline in vaccine preventable
diseases within the school-aged population. Specifically, Smallpox has been
eradicated and Polio has disappeared from the Western Hemisphere, while Measles
has been on a steady comedown (Hinman et al.). Day cares and academic
establishments are and will continue to be key components of the American
immunization system (Orenstein and Hinman).

Factors Influencing Vaccination Choice

            The factors involved in familial decision-making
whether to immunize their children include school enrollment, parental
knowledge and beliefs, community awareness, and accessibility to healthcare.

The main aspect that families consider when deciding to vaccinate is enrollment
in school. There are different requirements for each state regarding the
immunizations needed to attend and the exemption reasons accepted for a child
not to be vaccinated. In all 50 states, medical exemptions are allowed which
includes but is not limited to allergies, congenital conditions where vaccines
are contraindicated, and impairment of the child’s immune system (“Vaccination
Exemptions”). In 48 states, religious exemptions, conflicts between
immunization and religion that is not based upon personal or scientific
reasoning, is authorized (“Vaccination Exemptions”). Only 21 states grant
philosophical/personal exemptions, which are reasons the family does not want
the child to be vaccinated and they personally object to one or more
vaccinations (Orenstein and Hinman). These three exemptions exist so that
families who do not wish to vaccinate their children can still attend school. If
the family does not live in a state where personal exemptions are accepted and
there is no religious or medical reason to not vaccinate, the child must be
immunized.

Parental knowledge and beliefs include concerns about vaccine safety and
efficacy, evaluation of the risks and severity of a disease, and trust in the
healthcare system (Salmon et al.). These aspects help families weigh the
benefits and risks associated with immunizations. A family is more likely to
forgo vaccinating their child if they are not up to date on recommendations and
they believe vaccines will cause more harm than good (Omer et al.). A common
perception today is that, “…children receive too many vaccines,” (Omer et al.).

Another one of the numerous misconceptions of vaccinations is that Autism
occurs from immunizations, yet it is not supported by scientific evidence. This
had led to the refusal of parents around the U.S. to not vaccinate (Omer et al.).

Families also assess how dangerous diseases are and whether or not they feel
that their child is at risk of contracting them. Low perceived disease severity
and risk for disease is associated with noncompliance to vaccination, while an
increased perceived disease severity and fear of catching these diseases
influence families to obtain immunizations (Salmon et al.). Trust in the
healthcare system and government also impact the decision making process of
vaccination choices in households. Conspiracy theories and the monetary aspect
of vaccinations play a negative role in promoting them (Salmon et al.).

Community awareness about the effect immunizations have on public health
and access to healthcare are factors that are not often discussed but have
significant importance on families’ vaccination decisions. Children who have
the ability to get vaccinated protect those who cannot, such as children with
compromised immune systems and young infants (Hendrix et al.). Community
immunity is a term that is used to describe an area where most of the members
of that neighborhood are protected against a disease because a certain portion
of the population there is immunized, therefore preventing the spread to people
who cannot get vaccinated (“Community Immunity (“Herd Immunity”)”). It is
becoming more common for members to not get immunized because they believe
everyone else is vaccinated so they do not have to. They are unaware of how
their choices affect others in the community and are increasing the likelihood
for an outbreak to occur that could potentially cause multiple deaths (Hendrix
et al.). Those who are informed about community immunity are more likely to get
their children vaccinated. Access to healthcare also plays a large role in familial
decision-making. When a family has “access barriers” such as lack of
transportation or the inability to afford care, they have a harder time
receiving vaccines for their children and are less likely to be vaccinated
(Hendrix et al.). Others who do not have these barriers are able to receive
vaccines without difficulty and increase the likelihood to partake. The “access
barriers” are another pertinent factor on why community immunity is important
for families to be knowledgeable on. After analyzing the factors that determine
a family’s decision to vaccinate their children, we arrive at the ethical
dilemma whether it is morally right for vaccinations to be mandatory for
children in the United States.

Ethical Arguments

            Mandatory vaccination requirements
should not be effective in America because it is not only violating of the
ethical principles of autonomy and justice, but also adhering to paternalism. Autonomy
is having the right to decide what will happen to oneself (Guido 35). This is
applicable with children because parents are the decision-makers for them at
this point. Informed consent is a direct relation to this principle, and by
making immunizations mandatory this right is being taken away because they do
not wish to have vaccinations and are not giving consent to receive this care. Also
included within autonomy is independence, which is “…being able to act, reason,
and decide for oneself,” and agency, “…the power to be in command and
responsible for one’s actions,” (Guido 36). Families’ independence and agency
is taken against their will and they are not able make decisions and take
responsibility for those choices because the entirety of autonomy is being
removed from them. Our country is based upon the concept of freedom, except
this is a direct violation of families’ freedom. The ethical principle of
justice means to give each person what they deserve and being treated fairly
and equally (Guido 38). Specifically social justice can be applied because
requiring this health intervention puts the burden of accessing healthcare on
families where access may be limited or not feasible. This would be considered
unfair and not equitable. Paternalism is making the final decision for others and
is viewed as a negative ethical principle (Guido 37). Mandatory vaccination is
a very clear example of this because it allows the removal of the
decision-making process from families and in turn violates their freedom (Guido
37). Healthcare providers can also contribute to families’ decisions by
providing them with alternatives other than vaccines such as enhanced hygiene
to reduce mortality and morbidity (Van Delden et al.). This would include
better sanitation but the specific germs that cause disease still exist and
will continue to make people ill (“Vaccines are Effective”). Parents have the
right not to vaccinate their children in any of the 50 states if they have a
medical condition where immunization is not safe, but if they live in a state
where personal exemptions are not available to them then mandatory vaccination
requirements is violating autonomy, justice, and invoking paternalism.

            Compulsion immunization should be enabled
in the United States because it is promoting the ethical principles of
beneficence and nonmaleficence. Beneficence is the act of promoting good and is
the fundamental principle of health care ethics (Guido 36). By having children
immunized, families are helping to prevent disease outbreaks from occurring and
protecting the community. This is a critical principle to community immunity
because not everyone can receive vaccines but the ones who do are promoting the
health of others. This coincides with the ethical principle of nonmaleficence,
which is doing no harm and including preventing the suffering of others (Guido
36). The decision to vaccinate contributes to eradicating disease and reducing
the risk of spreading diseases to others and decreases the risk of inflicting
suffering upon the citizens around them. 
Immunizations are extremely important in the school-aged population
because they are considered super spreaders.  This is because they are around large amounts
of kids in close proximity and this is a probable environment for diseases to
break out and infect multiple people around the community. By vaccinating
children, we can reduce the spread of diseases in an area by almost 75 percent
and prevent the possibility of outbreaks from occurring.  Mandatory vaccination is how the U.S. protects
its own people and should be considered as an advantage.

Advocating for Mandatory Vaccination

            Compulsory immunization
requirements should be a mainstay in the American society because they are
immensely beneficial in hindering vaccine-preventable diseases from occurring,
save families money, allow children to receive education, and are a safe and
effective way to protect the future generations. To this day, smallpox and
polio are no longer issues in our population because vaccines have made this
possible. The measles vaccine has been very successful in regulating this
disease that used to cause a lot of mortality (Omer et al.). Recently,
outbreaks of measles have started to reappear because people are deciding to
not vaccinate their children, which then causes it to spread quickly within the
population that is not vaccinated. If this trend stays consistent for long,
more vaccine-preventable diseases are going to start popping up in the United
States population and morbidity and mortality rates will start to rise as they
did before vaccination became possible. Also, when people come in and out of
the U.S. who are from different countries where many vaccine-preventable
diseases are located, it puts everyone around them at risk for contracting
those diseases. Therefore, it is better for children to be vaccinated so that
there is no hazard in being in contact with these children coming from other
countries.

Families will save money by having their children immunized because they
will not pick up these diseases, therefore, the parents will not have to take
on extra medical bills or take time off of work to care for a sick child. Also,
if a child comes down with a vaccine-preventable disease they can be excluded
from school or day care. This has a negative impact on a child’s education and
is something that families should want to avoid.

Lastly, families who immunize their children are taking the preventative
steps of protecting the future generations from these illnesses and could
possibly even eradicate some of the vaccine-preventable diseases that we deal
with today. All vaccines that are given in the U.S. have to be approved by the
Food and Drug Administration before it can be used. A large amount of testing
is done, such as clinical trails, and is only approved if it is effective and
safe to be used by the population (“Vaccines are Effective”). Mandatory
vaccination should be upheld within America so that we can all live longer and
healthier lives.

Conclusion

            The United States of America relies
heavily on compulsory immunization to keep the population safe from dangerous
vaccine-preventable diseases because it is the most efficient public health
intervention that we have. As investigated, there are multiple factors that
play into the decision-making process for families to get their children
vaccinated and there are reasonable ethical arguments from both sides. Overall,
the controversy of this topic is intense, but the benefits of immunization
outweigh the negatives and the U.S. should continue to implement these
requirements for the greater good of our country. 

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